Do we need antibiotic prophylaxis in non-reconstructive breast surgery?

Introduction
Breast surgery is a clean surgery with variation in the reported incidence of surgical site infection (SSI) (2% to 38%) which in higher than expected in a clean surgery. Due to a higher reported incidence of SSI, there are variable protocols regarding the usage of antibiotics. Therefore, the objective of this study was to compare the incidence of infection after breast surgery with or without use of perioperative antibiotics.

Methods
This prospective study included 68 patients who underwent non reconstructive elective breast surgery and were randomized equally into two groups who received or who did not receive perioperative antibiotics. Demographic profile and factors which increase the incidence of SSI were recorded. All patients were followed until the wound healing was complete. SSI was diagnosed based on CDC criteria and wounds were graded according to Southampton wound score.

Results
Mean age, etiology of breast lesions, presence of risk factors and duration of drain kept was comparable among groups. No patient developed SSI in either group according to CDC criteria and developed only minor complications according to Southampton wound score (p > 0.05). In addition there was no significant interaction on two way mixed models ANOVA between use of antibiotics and on wound healing (p 0.101).

Conclusions
This study highlights that wound healing is not dependant on the use of perioperative antibiotics. Therefore, rational and effective use of antimicrobial agents for the prevention of SSI in clean breast surgeries will decrease the development of antibiotics related complications, antibiotic resistance and the cost of treatment.